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Opioids overused in treating migraines

Regardless of race, opioids were overprescribed for migraine treatment and level A acute analgesics were underused, indicating an opportunity for clinicians to improve migraine prescribing practices, according to research published in Cephalalgia.

“Racial disparities in migraine have been reported in the U.S.,” Larry Charleston IV, MD, MSc, and James Francis Burke, MD, both from the department of neurology at the University of Michigan, Ann Arbor, wrote. “Migraine in [blacks] is more frequent, more severe, more likely to become chronic and associated with more depression and lower quality of life compared to non-Hispanic Whites. It is possible that racial differences in prescribing practices contribute to these differences, but little is known about the quality of migraine prescribing patterns in the U.S. or whether racial differences exist.”

Charleston and Burke evaluated differences in quality of migraine care by race. Using data from the National Ambulatory Medical Care Survey, they estimated racial differences in the use of migraine prophylactic and abortive medications. They used the American Academy of Neurology Headache Quality Measure Set (AAN-HQMS) to define the quality of migraine care and to assign patients to one of four categories for their abortive medications (no abortive agent prescribed, all high-quality abortive agents, some low-quality abortive agents or any opiate agent) and prophylactic medications (no prophylactic agent, all high-quality prophylaxis, some low-quality prophylaxis or all low-quality prophylaxis). After applying weights from the National Ambulatory Medical Care Survey, the researchers used descriptive statistics to make racial comparisons between blacks, non-Hispanic whites or Hispanics. They assessed 2,860 visits, which represented about 50 million migraine visits from 2006 to 2013 in the United States.

Results indicated that no prophylactic treatments were received by 41.3% of black, 40.8% of non-Hispanic white and 41.2% of Hispanic patients. Level A prophylaxis was exclusively received by 18.8% of black, 11.9% of non-Hispanic white and 6.9% of Hispanic patients. No abortive treatments were received by 47.1% of black, 38.2% of non-Hispanic white and 36.3% of Hispanic patients. Any Level A abortive agents, such as triptans or Dihydroergotamine, were received by 15.3% of black, 19.4% of non-Hispanic white and 17.7% of Hispanic patients. None of these differences were statistically significant.

Nearly 40% of all patients were not prescribed any abortive medication.

“This shows an underuse of medications with high-quality evidence,” Charleston said in a press release. “Even for patients being prescribed an abortive medication, we found 27% of them were given at least one low-quality abortive medication. Better options do exist.”

Out of all patients, 15.2% had a prescription for an opioid; however, the researchers found no significant racial differences.

“We found that migraine disorders are likely undertreated with prophylactic medications,” Charleston and Burke concluded. “Similarly, suboptimal migraine abortive prescribing patterns exist — migraine patients receive opioids about as commonly as they receive medications with high quality evidence. ... Understanding what drives these prescribing patterns and improving overall migraine prescribing should be a central concern for headache care practitioners, quality improvement initiatives and a target of future interventions.” – by Alaina Tedesco

Disclosures: Charleston reports no relevant financial disclosures. Burke reports receiving payments from Astra Zeneca.